Effects of pulsatile and nonpulsatile cardiopulmonary bypass on cerebral perfusion in the patients who had coronary revascularisation with opeh heart surgery technique

Although it has been thought that the complications due to non-pulsatile blood flow should be lessen with the utilization of pulsatile perfusion during cardiopulmonary bypass (CPB), there is not enough literature about the probable beneficial effectts on cerebral perfusion. In this study we aimed to determine whether the utilization of pulsatile or nonpulsatile CPB differs on the cerebral circulation by the measurements of biochemical serum markers and the jugular bulb oxygen saturation (SjVO2) in adition to near- infrared spectroscopy (NIRSAfter obtaining informed consent, 18 patients scheduled for coronary revascularization on CPB were included to the study. After aortic clamping non-pulsatile and pulsatile perfusion were both performed for each 10 minute periodes. S100ß, adrenomedullin (ADM), NSE and SjVO2 measurements were performed 10 minutes before anesthesia, during nonpulsatile perfusion, during pulsatile perfusion and 10 minutes after CPB. Niroxope 401 was used for NIRS measurements14 patients were male ( 77.8 %) and four patients were female (22.2 %). The mean age was 59.06±10.40 and the mean ejection fraction was 50.67 ± 13.39 %. There were not statistically differences between both perfusion regimes as the mean arterial blood pressures (6726±7.01/68.71±527 mmHg) and the serum hemoglobin levels (8.64±1.32/8.51±1.29 mg/dl). The postoperative neuro-kognitive dysfunction rate was 27.8 % and the serebro-vascular event rate was 11.1 %. The increasing values of s100ß during non-pulsatile perfusion were decreased significant statistically with pulsatile perfusion. There was significant correlation between the cross clamping, CPB times and S100ß levels. Off-pump NSE levels and ADM levels during pulsatile perfusion and after CPB were statistically higher. There were not statistically differences between the perfusion types for NSE, SjVO2 and NIRS measurementsWe think that the decrease of s100ß levels during pulsatile perfusion is the striking point of this study. We also think that there is need for more studies with extended patient series to prove that the neurologic complications due to CPB should be lesson with pulsatile perfusion.